FMS Vendor File Update Request Form.pdf
PDF 270 KB Posted
- Solicitation number
- 36C26226Q0811
About this file
This is a Vendor Information form used by the Veterans Affairs (VA) department to collect and verify essential data for registering new vendors in the VA database.
The form captures comprehensive vendor identification and business details, including the requestor information, vendor name (with doing business as/legal name), physical and mailing addresses, and contact information (phone, fax, email). Vendors must provide either a Tax Identification Number (TIN) or Social Security Number (SSN), which are mandatory fields. The form also collects payment address details, point of contact information, and account numbers. For vendors with existing contracts, the form requires contract number, beginning and expiration dates, Free on Board (FOB) terms (Destination or Origin), and prompt payment discount terms (such as 2%/10, 1%/20, or N/30). Additional required information includes the vendor's 1099 indicator status, business type classification under FPDS (Small, Large, Outside VA, or Other Entities), and socioeconomic group designations (such as Small Disadvantage Business, Veteran-Owned, Woman-Owned, Hubzone Small Business, Historically Black College/University, or Javits-Wagner-O'Day Program participation). The form requires vendors to provide their Dun and Bradstreet Number and confirm Central Contractor Registration (CCR) enrollment, both mandatory for federal contracting eligibility. Finally, the form mandates verification of vendor status through two federal exclusion databases (http://epls.arnet.gov/ and http://exclusions.oig.hhs.gov/) before any vendor information is entered into the VA system, with failure to complete these checks potentially resulting in administrative action.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| 36C26226Q0811 0003_1.docx | DOCX document | |
| 36C26226Q0811 0002_1.docx | DOCX document | |
| 36C26226Q0811 0002.docx | DOCX document | |
| Corrected - 36C26226Q0811 0001.docx | DOCX document | |
| 36C26226Q0811 0001.docx | DOCX document | |
| 36C26226Q0811 0001_1.docx | DOCX document | |
| VA10091.pdf | ||
| S02 - RFQ - 36C26226Q0811 - Dock Lever.pdf | ||
| 36C26226Q0811_1.docx | DOCX document | |
| W-9 Form.pdf |
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Text version
VENDOR INFORMATION
1. REQUESTOR:
2. SERVICE:
3. EXTENSION:
4. VENDOR NAME:
Doing Business As/Legal Name:
5. VENDOR ADDRESS
Physical Location:
Mailing Address:
City:
State/Zip:
6. VENDOR TAX IDENTIFICATION NO. or
SOCIAL SECURITY NUMBER:
(Mandatory field must enter one or the other)
TIN:
SSN:
7. VENDOR PHONE & FAX NUMBER:
Phone:
Fax:
Email: :
8. PAYMENT STREET ADDRESS:
Address:
City:
State/Zip:
9. POINT OF CONTACT:
10. ACCOUNT NUMBER:
11. Does Vendor have an existing contract? YES NO If answer is YES, please enter Contract Number:
(i.e. GS-, V797 or any other contract with payment terms N/30 and expiration date) Beginning Date: Expiration Date:
FOB: Destination Origin Prompt Payment Discount: _________ (i.e. 2%/10; 1%/20 or N/30)
12. 1099 Vendor Indicator: YES (Always YES except if FEDERAL Government) NO
13. Business Type (FPDS) (Must check one): Small Large Outside VA Other Entities
14. Socioeconomic Group: (Please check all that apply) Sm Disadvantage Bus Javits-Wagner-O’Day Hubzone Small Business Veteran-Owned Small Bus Woman-Owned Small Business Historically Black College & Univ./Min Institute Veteran-Owned Large Bus Woman-Owned Large Business None of the other business Veteran-Service Disabled
15. Purchase Card Accepted YES NO
16. DUN and BRADSTREET NUMBER: ___________________________ (Mandatory-if vendor does not have one they need to go to http://www.dnb.com to register.
17. Is Vendor registered with Central Contractor Registration (CCR)? YES NO (Mandatory-if vendor is not registered they can accomplish the task at: http://www.ccr.gov to register.
18. Before we may enter any new vendor information within the VA database the mandatory registration sites shall be checked along with the status of the vendor’s ability to do business within the Federal Government. Failure to check the mandatory field(s) could result in administrative action. The following two sites are your final check .
http://epls.arnet.gov/ & http://exclusions.oig.hhs.gov/
File details come from the government source that posted it. Updated .